Undiagnosed obstructive sleep apnea (OSA) comes at a steep price—$3.4 billion annually, to be exact. According to the American Academy of Sleep Medicine (AASM), that’s the dollar amount of the additional medical costs of untreated moderate-to-severe OSA in middle-aged adults every year.
Large-scale changes on a national level may be the best way to reach patients who are slipping through the cracks, and the AASM is endorsing a US House of Representatives bill to repair the system for OSA sufferers who are enrolled in Medicare. HR 4695, introduced on May 21, would add an apnea screening tool to the Welcome to Medicare physical exam, helping to identify at-risk seniors when they first join the program. “Early diagnosis and treatment of OSA improves health and quality of life, and may reduce Medicare patients’ risk of developing related chronic conditions. Treating OSA is a high value intervention, improving health while significantly reducing Medicare expenditures,” says AASM president Timothy I. Morgenthaler, MD.
CMS began covering the Welcome to Medicare physical in 2005 and has added other screening tools in recent years. It is estimated that 20% of current Medicare beneficiaries have OSA and that number is expected to grow with rising obesity rates, making an OSA screening questionnaire a timely addition, Morgenthaler says.
The bill has earned support from both sides of the aisle in Congress, which is noteworthy in today’s political climate. When Congressman Michael C. Burgess, MD (R-TX), introduced the bill, he issued a press release stating, “This legislation is a no-brainer: It’s bipartisan, and the potential for improved care among patients who suffer or may suffer from this illness is great.”
Of course, whereas screening more of the at-risk population may be a no-brainer, the next steps will require much brainpower. More screening is likely to create an influx of patients who will need follow-up care after being flagged for potential OSA, which could create a logistical quandary. I asked Morgenthaler by e-mail how he anticipates the care will be handled. “Ensuring adequate access to medical care is a challenge facing the entire healthcare system due to the expansion of healthcare coverage through the Affordable Care Act,” Morgenthaler told me. “The AASM has taken several proactive steps to begin addressing this challenge in the field of sleep medicine, promoting an integrated care paradigm for sleep medicine that fosters collaborative relationships with primary care providers and non-sleep specialists. More recently, the AASM invested in the establishment of the Welltrinsic Sleep Network and appointed a new Telehealth Protocol Task Force. Through these and other initiatives, the AASM is implementing a multi-faceted strategy to ensure that the value of care provided by sleep specialists is enhanced and accessible to all patients.”
Another concern I raised with Morgenthaler is the fear that increased utilization of CPAP, which would likely happen if the bill becomes law, could result in increased audit activity by CMS. He responded, “The clinical benefit of the PAP device must be documented in the patient record in order to obtain continued coverage for the device beyond the initial three months of therapy. Documentation of clinical benefit must include both a face-to-face clinical re-evaluation by the treating physician and objective evidence of adherence to use of the PAP device.” In other words, stay on the up-and-up and you won’t have to worry if you are audited.
The AASM is currently working to secure additional cosponsors of the House bill and a legislative sponsor in the Senate. If you want to show support for the bill, visit www.aasmnet.org/seniorssleep.aspx for actions you can take. The bill would apply to initial preventative physical exams on or after January 1, 2016—at which time we may be able to focus on cost savings, not losses.
Sree Roy is editor of Sleep Review. E-mail her at [email protected]